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Common autoimmune diseases include type 1 diabetes, ulcerative colitis, Crohn’s disease and celiac disease, psoriasis, multiple sclerosis, and rheumatoid arthritis, to name a few.
“Autoimmune diseases are disorders in which the immune system ‘attacks’ the body wrongly,” said study author Timothy Nielsen, researcher and doctoral student at the Children’s Hospital of Westmead Clinical School of the University of Sydney. The study was published Tuesday in JAMA Pediatrics.
The attack can result in “a ‘multi-organ’ disorder such as lupus, or an ‘organ-specific’ disorder such as autoimmune thyroid disease (Hashimoto’s thyroiditis or Graves disease),” said Nielsen by e-mail.
Neurodevelopmental disorders such as ADHD, learning disabilities and autism are caused by disturbances in fetal brain development during pregnancy, Nielsen said. Previous research has linked autoimmune diseases in autistic mothers, obsessive-compulsive disorder, and tics or Tourette’s syndrome in children, he said, but this is the one of the first studies to examine their role in ADHD.
“I hope these results don’t put too much stress on women with autoimmune diseases,” said Dr. Jenny Radesky, developmental pediatrician, assistant professor of pediatrics at Michigan Medicine CS Mott Children’s Hospital, who did not attend. in the study.
“I treat a lot of children with ADHD, and these results wouldn’t change the way I manage them,” Radesky said. “While children with ADHD can be a handful, I love their small, expansive, inquisitive minds and their unique ways of looking at things.
“Mothers with autoimmune diseases can work to have optimal control of their condition during pregnancy, but autoimmune diseases are not like smoking during pregnancy – another risk factor for ADHD – on which mothers have more direct control, ”she added.
Large longitudinal study
The study followed more than 63,000 full-term infants between July 1, 2000 and December 31, 2010 in New South Wales, Australia. Nielsen and her team identified 12,610 mothers with at least one of 35 common autoimmune diseases. Each of the pregnant women had a diagnostic code for an autoimmune disease in their linked hospital records.
A child was determined to have ADHD if there was a diagnosis of ADHD in the hospital or a record of a prescribed or filled prescription for stimulants.
All 12,610 offspring who were diagnosed with ADHD older than 3 years were included in the study and then matched to four children of the same age with mothers without any autoimmune disease. The two groups of children were then followed until the end of 2014.
The study also conducted a meta-analysis of existing research on the subject.
Together, the results showed that a diagnosis of any autoimmune disease, type 1 diabetes, rheumatic fever or rheumatic carditis (inflammation of the heart muscle), psoriasis, and hyperthyroidism was associated with an increased risk of ADHD in children at an older age.
Autoimmune disorders and inflammation
It is not yet clear exactly how a mother’s autoimmune disease might affect her unborn baby. Researchers hypothesize that maternal autoantibodies – those that attack the mother’s body – cross the placenta. Inflammatory molecules could do the same.
Once there, the chronic inflammation could alter the development of the fetal brain, possibly by affecting the innate immune cells of the developing baby’s brain, according to the study. Or maybe the inflammation alters epigenetic markers – the chemicals that turn genes on or off – on key genes for neurodevelopment in the fetus.
Another theory, according to the study, is that inflammation impacts the formation and function of synapses in a baby’s developing brain. Synapses are the small pockets of space between two cells that allow cells to pass messages and communicate.
“These changes can lead directly to ADHD symptoms, or they can make the child more vulnerable to environmental risk factors,” Nielsen said.
Previous research has shown that women with autoimmune diseases poorly controlled by drugs or other treatments could be a risk factor for poor pregnancy outcomes such as failure to thrive and premature labor, a Nielsen said.
“Our team is currently working on research into the causal mechanisms underlying the association between autoimmune diseases and ADHD,” he said, which could help determine whether “the severity of the disease , symptoms, use of medications or other inflammatory factors affect this risk. of ADHD. “
Knowledge is power
A pregnant woman with an autoimmune disease is only one of many risk factors for any neurodevelopmental disorder in children, Nielsen stressed, “but understanding the risk and expression of the disease is essential if we are to want to prevent and treat disease. ”
Knowing about such an association can enable women and their health care providers to “emphasize the importance of high quality multidisciplinary care for managing autoimmune diseases before and during pregnancy,” said Nielsen.
“This includes good preconception care and possibly avoiding pregnancy when disease activity is not well controlled,” he said.
Beyond that, it’s no one’s fault if a child develops a disorder due to a parent’s health condition, experts say.
“Sometimes parents stick with their guilt because a child’s ADHD is their ‘fault’. Said developmental pediatrician Radesky.
“When that happens, I try to redirect their mental energy to understand their child’s unique blend of strengths and challenges, why the child is behaving the way they do and how to advocate for supports,” he said. she declared.
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